Implementing New Services: Telehealth Billing and Compliance

Telehealth has changed how medical providers, mental health therapists, and addiction treatment professionals offer services to their patients. In a national study of 36 million working-age adults with private insurance claims data showed a 766% increase in telemedicine encounters in the first three months of the pandemic over previous years. The successful implementation of telehealth services relies on navigating the billing and compliance of the service. Implementation often presents unique challenges, and Hansei is here to help.

How Telehealth Transforms Healthcare, Mental Health, and Addiction Treatment

Telehealth, also called telemedicine, is a way for healthcare, mental health, and addiction treatment providers to offer health-related services to patients by using electronic information and telecommunication technology. In many instances, these encounters take place over the phone or via video chats on platforms specified by the provider. Telehealth allows for long-distance patient and provider contact, care, advice, support, reminders, education, intervention, monitoring, and remote admissions.

Implementing these systems can be complicated, especially if the provider is not up to date on the unique telehealth billing and compliance regulations required to implement it. Different types of providers and insurance companies have different requirements when billing for patients – implementing telehealth throws an additional curveball into the mix, requiring special attention to ensure financial stability and ethical practice.

Navigating the Complexities of Telehealth Billing

Medical billing requires staying up to date on the latest billing codes and insurance criteria – the implementation of telehealth is no different. For providers in the healthcare industry, including mental health services and addiction treatment centers, using the proper billing strategies means getting patient services paid for in a timely manner.

Hansei can help with telehealth billing implementation by ensuring the following:

• Accurate Coding and Documentation – Precise coding and documentation are the foundations of effective telehealth billing. Providers must ensure that all telehealth services are accurately documented and coded using appropriate Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes.
• Payer-Specific Rules – Different payers, including private insurance companies, Medicaid, and Medicare, may have distinct rules and regulations regarding telehealth coverage and reimbursement. Staying well-informed about these payer-specific requirements is crucial to revenue cycle management.
• Proper Use of Place of Service (POS) Codes – Telehealth services require the use of specific POS codes to differentiate them from in-person visits. Correctly applying these codes on claims ensures that payers understand the mode of service delivery.
• Billing Modifiers – Telehealth billing may require the use of specific modifiers to indicate the mode of telehealth service delivery (e.g., real-time interactive audio and video, asynchronous store-and-forward, or telephonic). Proficiency in using these modifiers is vital for accurate billing.
• Credentialing and Enrollment – Providers offering telehealth services must ensure that their practitioners are appropriately credentialed and enrolled with payers. Neglecting this step can result in claim denials and financial loss for the provider’s establishment.
• Compliance with State Regulations – Telehealth billing and compliance requirements can vary significantly from one state to another. Hansei specializes in helping providers navigate state-specific regulations and licensing requirements to ensure that billing is done correctly.

Upholding Ethics and Legal Standards Through Telehealth Compliance

In addition to billing complexities, providers offering healthcare, mental health, and addiction treatment services via telehealth must adhere to a wide range of legal and ethical requirements. These requirements are in place to protect the provider’s establishment and the clients they treat. In order to offer services like telehealth, providers must strictly adhere to all the rules and regulations. Key areas that Hansei can help with include:

• HIPAA Compliance – Ensuring the confidentiality of patient information is vital in healthcare. Providers must maintain HIPAA-compliant telehealth platforms to safeguard sensitive patient data.
• State Licensure Laws – Understanding and complying with state licensure laws is crucial in healthcare. Providers may need to obtain licenses in the state where the patient is located, which can be a complex process when offering telehealth services across state lines.
• Fraud and Abuse Laws – Healthcare, mental health, and addiction treatment providers must be well-versed in fraud and abuse laws, such as the False Claims Act and the Anti-Kickback Statute, to prevent fraudulent billing practices and illegal financial inducements. The medical billing solution that a practice uses should make this easy, ensuring that all laws are followed.
• Informed Consent – Obtaining informed consent from patients is a key component of telehealth compliance. Patients must be fully informed about the nature of telehealth services, including potential risks and benefits.
• Credentialing and Privileging – Establishing standards for credentialing and giving practitioners the privileges needed to deliver telehealth services helps ensure that only qualified individuals provide care.

Hansei’s Commitment to Telehealth Billing and Compliance

As a company specializing in medical billing services for healthcare, mental health, and addiction treatment providers, our commitment lies in supporting our clients through the successful implementation of telehealth services while ensuring compliance with legal and ethical standards. To empower our clients in this journey, we take the guesswork out of the billing and compliance processes. We communicate with our clients and advocate for them when the insurance companies deny claims and for the fair treatment of all the facilities we serve.

Contact us to learn more about implementing telehealth billing and compliance services from Hansei.